Bill Text: TX HB293 | 2021-2022 | 87th Legislature | Comm Sub
Bill Title: Relating to health benefit coverage for certain fertility preservation services under certain health benefit plans.
Spectrum: Moderate Partisan Bill (Democrat 8-2)
Status: (Introduced - Dead) 2021-05-13 - Placed on General State Calendar [HB293 Detail]
Download: Texas-2021-HB293-Comm_Sub.html
| 87R15990 JES-F | |||
| By: Collier | H.B. No. 293 | ||
| Substitute the following for H.B. No. 293: | |||
| By: Oliverson | C.S.H.B. No. 293 | ||
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| relating to health benefit coverage for certain fertility | ||
| preservation services under certain health benefit plans. | ||
| BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: | ||
| SECTION 1. Chapter 1366, Insurance Code, is amended by | ||
| adding Subchapter C to read as follows: | ||
| SUBCHAPTER C. COVERAGE FOR CERTAIN FERTILITY PRESERVATION SERVICES | ||
| Sec. 1366.101. APPLICABILITY OF SUBCHAPTER. (a) This | ||
| subchapter applies only to a health benefit plan that provides | ||
| benefits for medical or surgical expenses incurred as a result of a | ||
| health condition, accident, or sickness, including an individual, | ||
| group, blanket, or franchise insurance policy or insurance | ||
| agreement, a group hospital service contract, or an individual or | ||
| group evidence of coverage or similar coverage document that is | ||
| issued in this state by: | ||
| (1) an insurance company; | ||
| (2) a group hospital service corporation operating | ||
| under Chapter 842; | ||
| (3) a health maintenance organization operating under | ||
| Chapter 843; | ||
| (4) an approved nonprofit health corporation that | ||
| holds a certificate of authority under Chapter 844; | ||
| (5) a multiple employer welfare arrangement that holds | ||
| a certificate of authority under Chapter 846; | ||
| (6) a stipulated premium company operating under | ||
| Chapter 884; | ||
| (7) a fraternal benefit society operating under | ||
| Chapter 885; | ||
| (8) a Lloyd's plan operating under Chapter 941; or | ||
| (9) an exchange operating under Chapter 942. | ||
| (b) Notwithstanding any other law, this subchapter applies | ||
| to: | ||
| (1) a small employer health benefit plan subject to | ||
| Chapter 1501, including coverage provided through a health group | ||
| cooperative under Subchapter B of that chapter; and | ||
| (2) a standard health benefit plan issued under | ||
| Chapter 1507. | ||
| Sec. 1366.102. EXCEPTIONS. (a) This subchapter does not | ||
| apply to: | ||
| (1) a plan that provides coverage: | ||
| (A) for wages or payments in lieu of wages for a | ||
| period during which an employee is absent from work because of | ||
| sickness or injury; | ||
| (B) as a supplement to a liability insurance | ||
| policy; | ||
| (C) for credit insurance; | ||
| (D) only for dental or vision care; | ||
| (E) only for hospital expenses; or | ||
| (F) only for indemnity for hospital confinement; | ||
| (2) a Medicare supplemental policy as defined by | ||
| Section 1882(g)(1), Social Security Act (42 U.S.C. Section | ||
| 1395ss(g)(1)); | ||
| (3) a workers' compensation insurance policy; | ||
| (4) medical payment insurance coverage provided under | ||
| a motor vehicle insurance policy; | ||
| (5) a long-term care policy, including a nursing home | ||
| fixed indemnity policy, unless the commissioner determines that the | ||
| policy provides benefit coverage so comprehensive that the policy | ||
| is a health benefit plan as described by Section 1366.101; | ||
| (6) Medicaid managed care programs operated under | ||
| Chapter 533, Government Code; | ||
| (7) Medicaid programs operated under Chapter 32, Human | ||
| Resources Code; or | ||
| (8) the state child health plan operated under Chapter | ||
| 62 or 63, Health and Safety Code. | ||
| (b) This subchapter does not apply to a qualified health | ||
| plan, as defined by 45 C.F.R. Section 155.20, if a determination is | ||
| made under 45 C.F.R. Section 155.170 that: | ||
| (1) this subchapter requires the qualified health plan | ||
| to offer benefits in addition to the essential health benefits | ||
| required under 42 U.S.C. Section 18022(b); and | ||
| (2) this state must make payments to defray the cost of | ||
| the additional benefits mandated by this subchapter. | ||
| (c) If a determination described by Subsection (b) is made | ||
| as to a qualified health plan, this subchapter does not apply to a | ||
| non-qualified health plan if the non-qualified health plan is | ||
| offered in the same market as the qualified health plan. | ||
| Sec. 1366.103. REQUIRED COVERAGE. (a) Subject to | ||
| Subsection (b), a health benefit plan must provide coverage for | ||
| fertility preservation services to a covered person who will | ||
| receive a medically necessary treatment, including surgery, | ||
| chemotherapy, and radiation, that the American Society of Clinical | ||
| Oncology or the American Society for Reproductive Medicine has | ||
| established may directly or indirectly cause impaired fertility. | ||
| (b) The fertility preservation services described by | ||
| Subsection (a) must be standard procedures to preserve fertility | ||
| consistent with established medical practices or professional | ||
| guidelines published by the American Society of Clinical Oncology | ||
| or the American Society for Reproductive Medicine. | ||
| SECTION 2. This Act applies only to a health benefit plan | ||
| that is delivered, issued for delivery, or renewed on or after | ||
| January 1, 2022. | ||
| SECTION 3. This Act takes effect September 1, 2021. | ||
